11/04/2026
Bullet For MRCP Part-2
✅ Lung Cancer Investigation:
85-year-old smoker with severe COPD and weight loss has lung mass + Poor performance status + On exam: Reduced breath sounds + Investigation shows: 38mm peripheral mass, no nodes + Which of the following is the most appropriate next step in the management of this patient >> CT-guided percutaneous biopsy
✅ Acute Severe Asthma:
23-year-old woman with asthma has worsening wheeze despite back-to-back salbutamol + Speech limited + On exam: RR 32, PEF 40% + Investigation shows: Sats 94% on air + What is the most appropriate next step in the acute management >> IV magnesium sulphate
✅ Adult-Onset Still’s Disease:
36-year-old woman with daily fevers, sore throat, myalgia and salmon-pink rash + Increasing joint stiffness + On exam: Rash during fever + Investigation shows: Ferritin 3200, Neutrophilia + What is the most likely diagnosis >> Adult-onset Still's disease
✅ Toxic Alcohol Ingestion:
47-year-old man found confused and ataxic after handling car antifreeze + Alcohol dependence history + On exam: Slurred speech, normal fundoscopy + Investigation shows: Metabolic acidosis, envelope crystals + What is the most appropriate initial treatment >> Start fomepizole infusion
✅ Supraventricular Tachycardia:
28-year-old woman has sudden palpitations and light-headedness + History of similar episodes + On exam: HR 182, BP 106/68 + Investigation shows: Narrow complex tachycardia + What is the most appropriate initial management for this patient >> Adenosine